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Alcohol use disorders significantly contribute to burden of chronic HCV

Alcohol use disorders contributed to more than two-thirds of liver-related complications in adults discharged with chronic hepatitis C from French hospitals between 2008 and 2013, according to a recently published study.

“While we have no data to quantify the contributions of HCV treatment such as new direct acting antiviral drug combinations, it certainly seems that with their introduction the role of [alcoholic use disorders (AUDs)] has been overlooked in the discussion, as if all risks of liver-related complication disappear once these drugs are administered,” Michaël Schwarzinger, MD, from the Université Paris Diderot, and colleagues wrote. “Reality with recent increases in premature liver mortality in Western populations or recent reports of high rates of liver disease progression despite HCV eradication reminds us that lifestyle factors and especially heavy drinking will continue to be important, and more should be done to limit its impact.”

The aim of the study was to measure the contribution of AUDs and other liver-related complications on the burden of chronic HCV in patients. The study cohort comprised 97,347 patients with HCV aged 18 to 65 years who had been discharged from French hospitals between 2008 and 2013.

Liver-related complications were recorded in 17,699 and AUDs were the most frequent comorbidity of HCV, affecting 28.9% of the total cohort.

Patients with AUDs had the highest odds for developing liver-related complications (OR = 7.19; 95% CI, 6.9-7.5), including decompensated cirrhosis (OR = 7.63; 95% CI, 7.3-7.97) and primary liver cancer (OR = 4.23; 95% CI, 3.99-4.49). The researchers determined that AUDs contributed to 71.8% (95% CI, 66-76.8) of liver-related complications, including 72.2% (95% CI, 67.3-76.4) of decompensated cirrhosis cases and 63.1% (95% CI, 54.9-70) of primary liver cancers.

The odds of liver disease progression were significantly reduced among 5,274 patients with AUDs who underwent alcohol rehabilitation (OR = 0.4; 95% CI, 0.37-0.43) and among 4,968 patients with AUDs who practiced abstinence after rehabilitation (OR = 0.22; 95% CI, 0.2-.024) compared with 17,859 patients with uncontrolled AUDs.

Patients with AUDs were more likely to receive liver transplantation (OR = 4.28; 95% CI, 3.8-4.82) and more likely to die prematurely after developing liver-related complications (OR = 6.2; 95% CI, 5.85-6.58) compared with other patients. Overall, AUDs contributed to 67.4% (95% CI, 61.6-72.4) of 1,599 liver transplantations and 68.8% (95% CI, 63.4-73.5) of 6,677 liver deaths.

The number of liver transplantations did not increase during the study period, but the number of both liver-related deaths (P < .0001) and deaths not related to liver complications did (P < .0001).

“The present study reaffirms that AUDs remain the main factor of liver disease progression, liver transplantation, and premature liver death in individuals with chronic HCV infection in France,” the researchers wrote. “Evidence-based cost-effective alcohol interventions at the individual (ie, brief interventions and treatment) and the population level (ie, taxation, reduction of availability, marketing ban and reduction of ethanol content in beverages) need to be continued.” – by Talitha Bennett

Disclosures: Schwarzinger reports he is an employee of the Translational Health Economics Network. Please see the full study for the other researchers’ relevant financial disclosures.